Tuesday, March 21, 2017

What do you find in the kidney biopsy of
a patient with pre-eclampsia?
The immunofluorescence findings are somewhat variable with fibrin deposition
often being a prominent feature.

The renal
biopsy findings of preeclampsia closest to look in the context of the
pathologic patterns seen in thrombotic microangiopathies (TMA). The lesions of
preeclampsia share some similarities with and also some differences from those
of non-preeclamptic TMA, likely owing to their differing pathogenesis.

What is the LM finding?

The glomeruli are
enlarged and solidified (“bloodless”), as a result of narrowed or occluded
capillary lumens that are the result of swelling of the native endothelial
cells and, to a lesser extent, mesangial cells. The endothelial changes are
limited to the glomerular capillaries; arterioles are typically unaffected.
Thrombosis by light microscopy is decidedly unusual. In marked contrast, in
nonpreeclamptic TMA, thrombosis of vessels and/or glomeruli is a central
finding. Cases of severe preeclampsia with accompanying vascular thrombosis
often have clinical signs suggesting a superimposed nonpreeclamptic TMA. In
severe cases of preeclampsia, in particular as the lesions evolve/resolve,
mesangial interposition can be seen, a finding shared with other entities
resulting from chronic endothelial insult, such as “chronic” TMA or transplant
glomerulopathy. So essentially, it may appear on LM in some cases- as an MPGN pattern
of injury ( without the IF being positive for complements or immunoglobuins).
This form of injury is termed “Glomerular endotheliosis”

What is the EM finding?

Ultrastructural
analysis will show endothelial cells with loss of fenestrations with
cytoplasmic swelling, owing to fluid and lipid accumulation and capillary
occlusion.

What is the IF finding?

How is it different from your
“classic” non preeclamptic TMA that you might see with SLE or APLAS or in TTP?

The main
finding in the “classic” TMA is thrombosis of vessels and glomeruli as the main
finding with some endotheliosis. This is a rare finding in pre-eclampsia
related TMA unless it is very severe.

Saturday, March 11, 2017

Visual abstracts have flooded the social media world in the
last few months. Where did this come from and how does it impact nephrology
sharing of knowledge?

Looking back I found that these existed for many years in Chemistry
journals –also called graphical abstracts.
Visual or graphical abstracts are visual elements that are clearly and
in short figure formed conveying the main message of the research( or review)
paper. They are self explanatory and
together with the title of the paper convey the main message of the article.
Given the current attention spans of readers being short and many learners being “visual”, this method can be quite effective. Journals in
medicine are trying to play with this concept for their specific fields.

Dr. Andrew Ibrahim(https://www.surgeryredesign.com/)
, creative director of Annals of Surgery began this revolution in Medicine. As
per a twitter chat, he mentioned “ We pitched this idea to the editors of
Annals of Surgery and they loved it. It was clear in June 2016 that it
disseminated faster. This led to a case control cross over of 44 articles
between July and Dec 2016 and results are preliminary results are promising. The articles got read three times more if they
had a visual abstract!! Once in Dec 2016, I shared my primer, there are around
20 other journals doing this.”

In the world of Nephrology, Joel Topf took on this venture
for Nephjc.com and visual abstracts appeared for the first time in renal world
at recent journals club in Fall
of 2016.

Following that, the #nephmadness 2017 has featured many visual
abstracts, some pasted below

To top it all, CJASN
is the first renal journal to enter in the visual abstract world. Great
start and totally amazing to have a renal journal embrace this!

Here is an image showing early leaders of visual abstracts
( courtesy Andrew)

You can create both static and animated abstracts- both can be very important in relaying your message. I would
urge all educators to try this out.

This could make fellowship journal club more fascinating. Make your
residents/fellows create them. All researchers should simplify their ideas using
such techniques. All medicine journals should strongly consider this modality.

Monday, March 6, 2017

Every March, the nephrology social media scene is taken over by the one and the only- Nephmadness, an homage to the annual US college basketball tournament fondly known as March Madness. In early 2013, while I led the AJKD blog as editor, Joel Topf and Matt Sparks came up to me and said " Let's do March Madness version of Nephrology", Being surrounded mostly by Cricket and soccer( the real football) most of my childhood and life, March Madness was something I learnt from my nephrology buddies. The idea was totally amazing! What was even more amazing was that the AJKD editorial team took the risk with us on embarking on this venture. And then it was born- March 2013- the first ever Nephmadness competition( the modern version of Nephrology Uptodate). A collection of ideas, concepts competing year after year. I would recommend all to read prior years competitions- It's like reading a nephrology textbook but with fun and flavor and attitude-- totally cool! You can also read last year’s helpful guide, NephMadness for Dummies, for more details.Prior years winners wereAn editorial in AJKD highlighted this event in 2015. This is an example of reverse blogging leading to publication. Usually publications lead to blog posts and twitter events. The Nephmadness phenomenon lead to an invited editorial in the home journal describing the big event in Nephrology. The link is belowhttps://www.ncbi.nlm.nih.gov/pubmed/25704043This year the tournament has 32 nephrology concepts divided across 8 different topic areas, called regions. Each region has 4 concepts. We have selected content experts from each topic to help us determine the best concepts and vet the information we provide to make sure it is accurate, unbiased, and interesting. The topics are secret until the contest begins on March 7, 2017- this year. Visit the AJKDBlog to get more information in 2 days.

From 2013, to now, we have come a long way. More participants, more faculty, more involvement. This might have become the largest Medical online Game in history-- probably! I don't know of anything like this. If you do, let me know. If you don't, let the World records holders be ware!Come play and enjoy! and most important of all- learn.Students, fellows, residents, attendings, fellowship programs, all can participate.Check out @kidneyCathy from Australia doing a "what is nephmadness" for all of us.